FREQUENTLY ASKED QUESTIONS

You can count on us to deliver the benefits you expect
and deserve.

Employers ask

Health Options will work with you on a quote for a self-funded PioneerASO plan and help you transition from a fully-insured plan to PioneerASO. We also have a PioneerASO 'Step-up' program that starts with a fully-insured Health Option plan to helps you build and analyze the necessary claims data  to transition to PioneerASO. We work closely with your organization on medical management and wellness programs to deliver optimal containment of costs.

Brokers ask

Health Options will work with you and your client on a quote for a self-funded PioneerASO plan to help them transition from a fully-insured plan to PioneerASO. We also have a PioneerASO 'Step-up' program that starts with a fully-insured Health Option plan that helps your client build and analyze the necessary claims data to transition to PioneerASO. We work closely with your client organization on medical management and wellness programs to deliver optimal containment of costs.

Members ask

Upon enrollment, Health Options mails Members a welcome packet that includes Member ID cards and instructions on setting up your online portal. The online Member portal provides you access to personal information like claims and Member documents.

Our website has everything you need to get started with your new benefits plan. Setting up your secure, personal Member portal takes just a few minutes and gives you 24/7 online access to your plan benefits. Click on 'Sign in' at the top of the page to get started.

PPO stands for preferred provider organization. These plans provide coverage for both in-network and out-of-network services and providers.

  • PPOs require Members to select an in-network primary care provider (PCP) who has a contracted agreement with Health Options. In-network means we have a contract that states these providers will accept payment on the contracted dollar amount instead of their usual charges. Network providers cannot bill the Member for the difference between their charged rate and their contracted rate.
  • PPOs do not require Members to get a PCP referral for specialist care.*

*Note: many specialists do require referrals, even if our plans do not.

HSA stands for a health savings account. These accounts are a tax-free way for people covered by high deductible health plans to pay for qualified medical expenses.

  • HSA plans may include preventive drug coverage containing medications to help prevent the development of and reduce the risk of complications of chronic conditions and illnesses. These prescription drugs are identified on the formulary with an H.S.A notation. These drugs indicated as H.S.A. bypass the deductible. Members pay only the applicable co-insurance or co-payment amounts. Medical payments made from an HSA are tax-free.
  • Interest earned by an HSA is tax-free.
  • HSAs are portable, which means no “use it or lose it” restriction. You keep your HSA if change employers or stop working.
  • If your employer makes contributions to your HSA, those funds are yours. If you don’t use funds,
    they remain in your HSA each year, and your money continues to earn tax-free interest.
  • Only certain plans qualify for HSAs. Consult a tax professional for more information.

A PCP can be an in-network physician, physician assistant or specialist in internal medicine, family practice, general practice, pediatrics, obstetrics or gynecology. PCPs can also be an advanced practice registered nurse or certified midwife licensed by the applicable state nursing board. Your PCP is a partner in your healthcare, advises you, and provides treatment on a range of health-related issues. He or she may assist you in your interactions with specialists.

Out-of-pocket costs vary slightly according to your plan, but in general, co-pays, deductibles, and co-insurance are your out-of-pocket costs. Non-covered services are not included in out-of-pocket costs.

A co-payment is a fixed amount that you pay for a covered healthcare service, usually at the time you receive the service. Your co-pay is determined by your plan. Unless specified on your Schedule of Benefits, the deductible does not have to be met for the application of a co-payment. Co-payments do not count toward your deductible. Co-payments do count toward your out-of-pocket maximum.

An Explanation of Benefits (EOB) is a statement we will send you to explain what medical treatments and/or services were paid for on your behalf. EOBs are sent upon the completed processing of a medical claim. An EOB will explain the plan payment and your financial responsibility pursuant to the terms of the policy. If you need assistance reading or interpreting your EOB, please contact Member Services at (855) 624-6463.

The deductible is the amount you pay for certain covered services before your plan pays benefits. Payments for services that apply to the deductible are applied toward your deductible until the total is met. If you have a family plan of three or more people, you may collectively meet a family deductible, at which point all individual deductibles are considered met.

The co-insurance amount you owe is based on a percentage of the allowed amount on a claim. You and the plan each pay a certain percentage, which together equals 100%. This normally applies once a deductible has been satisfied for many covered services. Please consult your plan’s Schedule of Benefits for specific cost sharing information.

Plan Providers will file claims directly with the Plan. Members may need to submit a claim for reimbursement for services from a Non-Plan Provider.

Certain services and prescriptions require review and approval from the Utilization Management team or from the plan’s PBM partner, Express Scripts Inc., prior to allowing coverage by the plan. If you receive care from an in-network provider, your provider is responsible for obtaining these authorizations. If you receive care from an out of-network provider, it is your responsibility to obtain these authorizations. Call Member Services if you have any questions about our Prior Approval requirements.

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